An 84-year-old woman was diagnosed with cardiogenic shock requiring emergent percutaneous coronary intervention. After emergency percutaneous coronary intervention, transthoracic echocardiography indicated a 30-mm mobile thrombus with the largest diameter of 35 mm in the left atrium (panel A). She was induced for urgent left atrial thrombectomy. Transesophageal echocardiography revealed that the left intra-atrial thrombus had migrated into the left ventricle passing through the aortic valve (panel B and Supplemental Digital Content video 1, https://links.lww.com/ALN/D62). Considering the size of the thrombus and the likelihood of entering carotid arteries, vascular echography was immediately performed and revealed a thrombus in the right common carotid artery. However, cerebral oximetry indicated that oxygen saturation decreased gradually from 77 to 62% in 30 min on the right side versus a constant reading of 40% on the left side. The atrial thrombectomy was abandoned, and an endovascular thrombectomy was performed instead, which confirmed the diagnosis....
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Images in Anesthesiology|
March 2023
Thrombus Migration Just before Surgery
Kosuke Okada, M.D.;
Kosuke Okada, M.D.
1Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
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Takuma Maeda, M.D., MPH, Ph.D.
Takuma Maeda, M.D., MPH, Ph.D.
2Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
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Accepted for publication January 27, 2023.
Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
Correspondence: Address correspondence to Dr. Maeda: takuma@ncvc.go.jp
Anesthesiology Newly Published on March 2023. doi:
Citation
Kosuke Okada, Takuma Maeda; Thrombus Migration Just before Surgery. Anesthesiology Newly Published on March 17, 2023. doi: https://doi.org/10.1097/ALN.0000000000004523
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